Dear all, I just wanted to draw your attention to a variety of resources on the CLTS website that are relevant to this topic... My colleague Robert (Chambers) has written several blog and other reflection pieces on the subject of the links between WASH and undernutrition/tropical enteropathy/stunting etc and we have engaged with a variety of people on this subject. You can find some relevant resources here www.communityledtotalsanitation.org/search/site/nutrition

We are als very interested in hearing from others on the subject matter- so if you have relevant resources or research to share or would like to write a blog, case study etc on the matter, please get in touch
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You are also welcome to add our views to the existing blogs by leaving a comment and starting a discussion.

Best wishes,
Petra

Petra Bongartz
CLTS Knowledge Hub at the
Institute of Development Studies
Brighton
UK

Terre des hommes is working on malnutrition since long time. WASH is also part of our response first at health facilities level and then at community level.
We are very much interested by the experiences shared and new publication in this topic and we will support the working group as much as we can.
Best regards

Diarrhea, pneumonia and birth complications are the top three killers of children under age 5 worldwide. Diarrhea is also a leading cause of undernutrition in this age group and one-third to one-half of all child mortality cases are linked to undernutrition. If mothers and other caregivers used basic hygiene practices and had better access to safe water and adequate sanitation this could greatly reduce under 5 deaths and improve child nutrition.

Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Global Health, July 2013.

Background - Low haemoglobin concentrations and anaemia are important risk factors for the health and development of women and children. We estimated trends in the distributions of haemoglobin concentration and in the prevalence of anaemia and severe anaemia in young children and pregnant and non-pregnant women between 1995 and 2011.

Methods - We obtained data about haemoglobin and anaemia for children aged 6–59 months and women of childbearing age (15–49 years) from 257 population-representative data sources from 107 countries worldwide. We used health, nutrition, and household surveys; summary statistics from WHO’s Vitamin and Mineral Nutrition Information System; and summary statistics reported by other national and international agencies. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions and systematically addressed missing data, non-linear time trends, and representativeness of data sources. We quantiﬁ ed the uncertainty of our estimates.

Findings - Global mean haemoglobin improved slightly between 1995 and 2011, from 125 g/L (95% credibility interval 123–126) to 126 g/L (124–128) in non-pregnant women, from 112 g/L (111–113) to 114 g/L (112–116) in pregnant women, and from 109 g/L (107–111) to 111 g/L (110–113) in children. Anaemia prevalence decreased from 33% (29–37) to 29% (24–35) in non-pregnant women, from 43% (39–47) to 38% (34–43) in pregnant women, and from 47% (43–51) to 43% (38–47) in children. These prevalences translated to 496 million (409–595 million) non-pregnant women, 32 million (28–36 million) pregnant women, and 273 million (242–304 million) children with anaemia in 2011. In 2011, concentrations of mean haemoglobin were lowest and anaemia prevalence was highest in south Asia and central and west Africa.

Interpretation - Children’s and women’s haemoglobin statuses improved in some regions where concentrations had been low in the 1990s, leading to a modest global increase in mean haemoglobin and a reduction in anaemia prevalence. Further improvements are needed in some regions, particularly south Asia and central and west Africa, to improve the health of women and children and achieve global targets for reducing anaemia.

The puzzle of persistent undernutrition in India is largely explained by open defecation, population density, and lack of sanitation and hygiene. The impact on nutrition of many faecally-transmitted infections, not just the diarrhoeas, has been a blind spot. In hygienic conditions much of the undernutrition in India would disappear.

This study assessed the relationship of fecal environmental contamination and environmental enteropathy. It compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi across rural Bangladesh living in different levels of household environmental cleanliness. Results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.

This update by Dean Spears states that the effect of sanitation on human capital does not merely reflect wealth or other dimensions of development.Open defecation, which is exceptionally widespread in India, can account for much or all of the excess stunting in India.

Cryptosporidiosis is a significant disease in young children. The Global Enteric Multicenter Study found that Cryptosporidium is a major contributor to infant and toddler diarrheal illness in seven countries in Africa and Asia. Cryptosporidiosis was associated with a relatively high case fatality and nutritional stunting.